PSI & VCT: Social Marketing Approaches to Voluntary Counseling and Testing Hang Trinh, MD, MPH Senior Program Manager PSI/Vietnam - August 2005

Strategic Objectives of PSI Vietnam Increase knowledge of and demand for VCT services by select target groups Increased capacity of partners to implement social marketing interventions Addressing issues related to decreased stigma of HIV-positive persons and the use of VCT services in high-prevalence communities

Target populations Injecting Drug Users Sex Workers (Direct (street based) and Indirect (karaoke, massage) Sexual partners of most at risk populations Short, Most at Risk Populations (MARP)

Increased knowledge of and demand for VCT Simply: Get more vulnerable groups to access VCT services HOW? Development of an integrated marketing and communications campaign

A Social Marketing Strategy Formative Research – Identify the barriers of MARPs to accessing VCT – Develop messages to break down those barriers Segmentation and focused targeting Develop the marketing strategy Develop the communications campaign Monitoring and evaluation

SUMMARY OF PSI/VN’S QUALITATIVE RESEARCH ON VCT

What we wanted to know How do MARP perceive VCT: Understand motivational triggers, perceived barriers and benefits to accessing VCT Users‘ of VCT past experiences: Obtain insight into the benefits and advantages of knowing HIV status

Why? To develop a focused communications campaign to increase informed demand for VCT Simply put, convince vulnerable populations to access VCT

Methodology 14 In-depth interviews w/prior users of VCT 16 Focus Group Discussions w/target group (generally non users): Study Groups  IDUs  SWs (Direct and Indirect)  Sexual Partners of IDUs Target Sites: Hanoi and Hai Phong

Many misconceptions of VCT dominate, especially w/SWs: Few non-users know where VCT sites are located Knowledge of services is vague, and VCT is not well differentiated from hospital testing Past negative experiences with health care system shape feelings about VCT

Barriers to Access (Linked to Stigma and Fear) Stigma/discrimination against PLWHA, as well as behavioral related stigma (IDU and SW) “I’m sure that 100 drug addicts all have the same thought. They’re afraid of being isolated, kept away, and losing the chance to go back to their family.” (Hanoi IDU) Being recognized by friends or acquaintances Issues related to Confidentiality Fear of positive result, and with no cure for HIV/AIDS, there is no reason to get tested—hopeless and depression that would accompany.

Barriers to Access (More surprising) Among sex workers the fear that testing will result in loss of income “We accept the fact that we might contract the disease, however we don’t dare to go for a medical examination because people might start rumors about our problem and keep away from us. Consequently, we will find it difficult to continue our jobs, to earn money, to feed our children. This is a reality”. (Hai Phong street-based sex worker ) Fear of being treated badly by health workers

Motivational triggers for accessing VCT A family member, friend demonstrating symptoms of AIDS Outreach workers can be crucial “Now there is a peer group. They came to my house and invited us to join the group activities. We joined for one meeting and last Sunday went for the 2nd time. Then I noticed my husband got sick, so my husband and I planned to go [for VCT].” (Hanoi partner of IDU)

Motivational triggers for accessing VCT A close call To make a ‘New Start’ (relationship, getting clean) “There is a girl who loves me. I will go for the test in order to protect her. I really love her and will make a new start if I’m not infected.” (Hanoi IDU)

Perceived Benefits of accessing VCT Opportunity to protect partners and family members from infection “The test result is positive. I use drugs and I have to accept that. I’m okay, but knowing that I am positive, I’m thinking of my wife. She is my hope.” (Hai Phong IDU)

Perceived Benefits of accessing VCT Peace of mind and relief from anxiety and worry: Relief is the converse of the fear of hopelessness if found positive. Opportunity to protect oneself from becoming infected (especially for CSWs) A chance to start again with a brighter future. Access to medical care

Key Desired Characteristics of VCT services: What do people want? Confidential and Anonymous Testing. Friendly, sympathetic, and respectful staff Staff they don’t already know Convenient (times & locations) Counseling with accurate information to prevent transmission. Accurate test results Free or low cost service Quick results with short waiting time Routine testing or making it "normal" was proposed as a way to ameliorate the anxiety surrounding testing. If everybody does it, it won’t be so embarrassing or frightening.

Started off in Beginning with a Real Social Marketing Challenge Creating demand for a service: With high latent need (but very low perceived need) With possibilities of being highly stigmatized Capable of making frightening revelations Whose benefits are neither tangible nor clear That initially promised no curative or medical back up.. And the preventive benefits were not really widely understood

Media Messages: Phase 1 (2005) Increased general awareness of VCT as a new service available in Vietnam through promotion of specific VCT centers. The goal is for populations to: be well aware of what VCT is; and that promoted services are a quality and highly confidential service; know exactly where such services are located in their community; feel confident that they will be welcomed at these VCT sites;

Provide Correct Site Information  Locations  Clarification of Services offered  Operating hours Media Messages: Phase I (2005)

Define Quality of Service  Confidentiality  Friendly, sympathetic staff attitude  Accurate, timely results Media Messages: Phase I (2005)

Emphasizing Counseling and Talking  Calm anxieties  Opportunity to “Work out problems”  “Protect yourself and your family” Media Messages: Phase I (2005)

Sample of Concept Design

Emphasize benefits of knowing serostatus Building personal conviction in the perceived benefits of learning one’s status via VCT, including: to protect loved ones from possible infection; to plan for a brighter future- including marriage or children, new work; if you are negative, learn ways of staying negative; peace of mind and relief from worry; if you are positive – access to medical care; Media Messages: Phase II (2006)

Signs should:  avoid using “HIV” or “AIDS” Branding Sites will increase awareness and acceptability of sites, and serve to link advertising campaigns with sites Promotional materials should:  Clearly identify sites as VCT clinics  Give detailed directions and hours Signage

Brand Name & Logo Brand name: Implying a new beginning in life Logo: Depicting “Hope” through rising sun and vibrant colors Product description: “Counseling and Testing Centre” (Not “HIV/AIDS center”) Includes desired action right in slogan itself: “A New Horizon!”

Lowering Stigma is essential  Use role models to break the silence  Make testing a part of normal life  Behavioral stigmatization needs to be addressed Long Term (and not easy)

Conclusions Social marketing can be successfully used to increase demand for VCT services Research is key to prioritizing messaging Two phases will be utilized, emphasizing – Knowledge of VCT, service attributes, and locations – Benefits of accessing VCT Stigma against PLWHA and discrimination of specific groups (IDU/SW) is very high and should be addressed concurrently with VCT promotion activities for maximum benefit